V2521 — Contact lens, hydrophilic, toric, or prism ballast, per lens
HCPCS Level II V-code · short descriptor: “Cntct lens hydrophilic toric”
- Code system
- HCPCS Level II
- Family
- V — Vision & hearing services
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
V2521 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $214.82 to $435.59 depending on state and rural status.
Former-CBA payment limits: ceiling $296.38 · floor $222.28
| State | Non-rural | Rural |
|---|---|---|
| AK | $214.82 | — |
| AL | $222.28 | — |
| AR | $236.36 | — |
| AZ | $222.28 | — |
| CA | $222.28 | — |
| CO | $247.23 | — |
| CT | $230.86 | — |
| DC | $262.20 | — |
| DE | $262.20 | — |
| FL | $222.28 | — |
| GA | $222.28 | — |
| HI | $229.73 | — |
| IA | $263.64 | — |
| ID | $222.28 | — |
| IL | $296.38 | — |
| IN | $296.38 | — |
| KS | $263.64 | — |
| KY | $222.28 | — |
| LA | $236.36 | — |
| MA | $230.86 | — |
| MD | $262.20 | — |
| ME | $230.86 | — |
| MI | $296.38 | — |
| MN | $296.38 | — |
| MO | $263.64 | — |
| MS | $222.28 | — |
| MT | $247.23 | — |
| NC | $222.28 | — |
| ND | $247.23 | — |
| NE | $263.64 | — |
| NH | $230.86 | — |
| NJ | $296.38 | — |
| NM | $236.36 | — |
| NV | $222.28 | — |
| NY | $296.38 | — |
| OH | $296.38 | — |
| OK | $236.36 | — |
| OR | $222.28 | — |
| PA | $262.20 | — |
| PR | $435.59 | — |
| RI | $230.86 | — |
| SC | $222.28 | — |
| SD | $247.23 | — |
| TN | $222.28 | — |
| TX | $236.36 | — |
| UT | $247.23 | — |
| VA | $262.20 | — |
| VI | $296.38 | — |
| VT | $230.86 | — |
| WA | $222.28 | — |
| WI | $296.38 | — |
| WV | $262.20 | — |
| WY | $247.23 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related V-codes
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